Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

  • MUHAMMAD ANWAR ULLAH Department of Neurosurgery, Lady Reading Hospital, Peshawar
  • FAHIM ULLAH KHAN Department of Pharmacy, Abasyn University, Peshawar
  • MUHAMMAD USMAN Department of Neurosurgery, Lady Reading Hospital, Peshawar
  • MOHAMMAD ISHAQ Department of Neurosurgery, Lady Reading Hospital, Peshawar
  • ZAHID KHAN Department of Neurosurgery, Lady Reading Hospital, Peshawar
Keywords: Endoscopic third ventriculostomy, Obstructive hydrocephalus, CSF leak, Complications


Objective:  To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus.

Material and Methods:  The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death.

Results:  Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%).

Conclusion:  Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes.


1. Grunert P, Charalampaki P, Hopf N, Filippi R. The role of third ventriculostomy in the management of obstructive hydrocephalus. Min-Minimally Invasive Neurosurgery, 2003; 46 (01): 16-21.
2. Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment. Neurosurg Rev. 1999; 22 (2-3): 67-93.
3. Bayston R. Hydrocephalus shunt infections. J Antimicrob Chemother. 1994; 34 (suppl_A): 75-84.
4. Dandy W. An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp. 1922; 33: 189-90.
5. Scarff JE. Treatment of obstructive hydrocephalus by puncture of the lamina terminalis and floor of the third ventricle. J Neurosurg. 1951; 8 (2): 204-13.
6. Mixter W. Ventriculoscopy and puncture of the floor of the third ventricle: preliminary report of a case. Bost. Med. & Surg. J. 1923; 188 (9): 277-8.
7. Hirsch J-F. Percutaneous ventriculocisternostomies in non-communicating hydrocephalus. Shunts and Problems in Shunts: Karger Publishers; 1982: p. 170-8.
8. Jones RF, Kwok BC, Stening WA, Vonau M. The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invas Neurosur. 1994; 37 (01): 28-36.
9. Greenberg M. Handbook of Neurosurgery. 6-th ed. New York, 2006: 289-365.
10. Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Ped. 2011; 7 (2): 143-6.
11. Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract. 2012; 3 (2): 163.
12. Sokal P, Birski M, Rusinek M, Paczkowski D, Zieliński P, Harat A. Endoscopic third ventriculostomy in treatment of hydrocephalus. Videosurg Other Miniinvasive Tech. 2012; 7 (4): 280.
13. Yadav YR, Parihar V, Agrawal M, Bhatele PR. Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus. Neurology India, 2011; 59 (6): 855.
14. Brohi SR, Brohi AR, Sidiqui MA, Mughal SA, Saeed S. Outcome of endoscopic third ventriculostomy in hydrocephalus. J Surg Pak. 2010; 15 (1): 25-8.
15. Ali M, Usman M, Khan Z, Khan KM, Hussain R, Khanzada K. Endoscopic third ventriculostomy for obstructive hydrocephalus. J Coll Physicians Surg Pak. 2013; 23 (5): 338-41.
16. Mohanty A, Santosh V, Devi BI, Satish S, Biswas A. Efficacy of simultaneous single-trajectory endoscopic tumor biopsy and endoscopic cerebrospinal fluid diversion procedures in intra-and paraventricular tumors. Neurosurg Focus, 2011; 30 (4): E4.
17. Chen CC, Kasper E and Warnke P. Palliative stereotactic-endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus from cerebral metastasis. Surg Neurol Int. 2011; 2: 76.
18. Feng H, Huang G, Liao X, Fu K, Tan H, Pu H, et al. Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis. J Neurosurg. 2004; 100 (4): 626–33.Doi: 10.3171/jns.2004.100.4.0626.
Original Article